OFFICE OF INDIAN AFFAIRS 


RC 313 
. A54 
1910 
Copy 1 


MANUAL 

ON 

TUBERCULOSIS 


ITS CAUSE, PREVENTION, AND 
TREATMENT 


JOSEPH A. MURPHY, M. D. 

MEDICAL SUPERVISOR, U. S. INDIAN SERVICE 



WASHINGTON 

GOVERNMENT PRINTING OFFICE 
1910 





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This pamphlet was specially prepared to give to the Indian in the simplest way 
the facts which he should know in regard to tuberculosis, and to show him in a prac¬ 
tical way how to modify his home conditions so as to prevent the spread of the disease. 

It is intended to be placed in the hands of every Indian pupil in the Indian schools 
who can read. The teacher should teach the subject by sections, and at the close of 
the school allow the pupil to cover the book and take it home to instruct the family 
and keep for reference. 

It is intended also for distribution to all employees of the Indian service for their 
instruction, and in order that they may be able to teach the facts to the Indians with 
whom they come in contact. They should retain the pamphlet for reference. 

Physicians and field matrons should distribute the pamphlet in the homes where 
the Indians can read, and where members of the family have tuberculosis. Addi¬ 
tional copies for use in this way may be obtained from the Indian Office by request. 

2 




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MANUAL ON TUBERCULOSIS. 


TUBERCULOSIS (OR CONSUMPTION) IS CONTAGIOUS— 
IT CAN BE PREVENTED AND CURED. 

WHAT IS TUBERCULOSIS? 

Tuberculosis of the lungs is -also called “ consumption.” It is a dis¬ 
ease which very slowly weakens the body until it may finally cause 
death. 

At first there is usually a slight cough and a small amount of mat¬ 
ter spit up from the lungs. Gradually the body becomes thinner and 
weaker, the skin becomes pale, the heart beats faster, and the breath¬ 
ing becomes quicker, especially after exercise. 

If the proper care is not taken, the cough slowly becomes worse, 
there may be bleeding from the lungs, and the blood spit up. The 
body becomes hot in the evenings; there is fever. At night there 
may be sweats. The appetite becomes poor. Cough, fever, and 
sweats increase. A great deal of matter may be spit up from the 
lungs until finally the lungs are so badly diseased that death results. 

This disease may be cured if the 'proper care is taken of the body. 

INDIANS HAVE TUBERCULOSIS MORE THAN OTHER PEOPLES. 

The doctors have found that a great many Indian tribes are slowly 
dying of tuberculosis. Whole Indian families die of it—lathers, 
mothers, and their children. The children have to be sent home 
from the schools because of this sickness. Many Indians have the 
disease for a long time, but may finally get well. 

TUBERCULOSIS IS CAUSED BY GERMS. 

Tuberculosis of the lungs (or consumption) is caused by little plants 
which are so small that they can not be seen unless they are looked 
at through the microscope. 

The microscope makes them seem many hundred times larger than 
they are, and through it they look like very small, short threads. 
These plants are called tuberculosis germs. 

When a few of these germs get into the lungs, they grow there 
till there are many millions of them. They are like the seeds of 
weeds which get into a plowed field and grow until there are many 
weeds all over the field. When tuberculosis germs grow in the body 
they destroy the lung and cause the one who has them to cough and 
spit. Sometimes the germs destroy the blood vessels and cause 

3 



4 


MANUAL ON TUBEKCULOSIS. 


the lungs to bleed. This blood comes up into the mouth and is 
spit out. 

The matter which a person who has tuberculosis spits up from the 
lung is called sputum. It frequently has in it large numbers of tuber¬ 
culosis germs. 

Tuberculosis germs do not grow in strong lungs, but grow very 
rapidly in weak lungs. 

Everything which makes the body weak weakens the lungs also, so 
that the tuberculosis germs grow in them more easily. 



Fig. 1.—The Microscope. 

In order to see the germs they must be placed on a glass plate and looked at through the microscope. 

Breathing the air of a crowded room or the dust caused by sweeping 
is bad for the lungs. 1 6 

If one does not get enough food or does not eat the right kinds of 
ood to build up the body, then the body and the lungs become weak. 

loo violent exercise, like dancing too long without rest, or work 
which tires the body too much or keeps one up too long without 
sleep, weakens the body and the lungs also. 

Exposure to cold or wet for a long time without sufficient clothing 
has the same effect. & 

The drinking of whisky or the use of tobacco is also weakening. 





MANUAL QX TUBERCULOSIS. 


5 


Diseases such as measles, whooping cough, pneumonia, and influ¬ 
enza frequently leave the body in a weakened condition. 

If the tuberculosis germs get into the body or lungs of one weakened 
by any of these conditions, they grow very rapidly and the person 
soon becomes sick with tuberculosis. 

WHERE DO THE TUBERCULOSIS GERMS COME FROM? 

From the dried sputum in the house dust. —People and animals sick 
with tuberculosis are the source of all the germs. Millions of tuber¬ 
culosis germs grow in the lungs of those who have tuberculosis. The 
matter wdiich they spit up from the lungs contains countless numbers 



When the tuberculosis germs are looked at through the microscope they look like these little marks. 

of these germs. When this matter is spit on the floor of the house 
the sputum dries, but the germs live there for months. They mingle 
with the dust on the floor and are very easily blown up into the air 
of the room when the floor is swept or walked upon. 

From moist drops thrown out in coughing. —Sometimes the little 
drops of fluid coughed from the lungs contain a great many tubercu¬ 
losis germs. These drops settle on the food or on the floor and in this 
way are spread about the house. 

From tubercular sores of the neck. —Sores on the neck frequently 
contain tuberculosis germs. The matter and germs from these sores 
gets upon the cloths used to cover the neck. 

From dishes , pipes , and clothes of the sick. —Those who have tuber¬ 
culosis are likely to get the germs from their mouths onto their pipes, 





6 


MANUAL ON TUBERCULOSIS. 


cups, spoons, handkerchiefs, towels, blankets, and other things which 
they handle or place in the mouth. 

From the milk and meat of tubercular cows. —Cows sometimes have 
tuberculosis. The milk or meat from these sick cows frequently con¬ 
tains the tuberculosis germs. 

HOW DO TUBERCULOSIS GERMS GET INTO THE BODY? 

No one can take tuberculosis unless the tuberculous germs get into 
and grow and multiply in the body. 

How do these germs get into the bodies and lungs of well people ? 
They enter the body in three ways: (1) Through the air which we 
breath; (2) in the food; and (3) through the skin. 

The germs are breathed into the lungs.— The air and dust in houses in 
which persons who have tuberculosis have spit on the floor contain 
tuberculosis germs. When this is breathed into the lungs the germs 
remain and grow. 

Tuberculosis germs may be taken into the body on food. —Milk or meat 
from tubercular cows, and food which has not been covered or pro¬ 
tected from dust or flies, may contain tuberculosis germs. When the 
food is eaten the germs live and remain and grow in the body. 

Flies frequently bring tuberculosis germs to the food by walking 
in the sputum on the floor and then walking on the food. 

The germs may get upon the food from unwashed hands and thus 
be taken into the body. 

Tuberculosis germs may enter the body through cuts in the skin .— 
The dirt which collects on the skin may contain the germs which may 
enter the body through a slight scratch or wound. 

HOW THE GERMS ARE KILLED. 

Tuberculosis germs live for months after being spit out upon the 
floor. They should be killed in order that they may not get into the 
lungs of well people and give them the disease. 

Fire, boiling water, strong sunlight, and poisonous drugs will kill 
the germs. The free use of soap and water will remove them. If 
plenty of fresh air is admitted to the house it blows them away. 

Fire and boiling water kill the germs. —Burning in the fire or boiling 
in water are the best methods of killing the germs. All sputum should 
be burned. It may be spit directly into the fire or into folded pieces 
of paper to be placed in the fire. 

If cups or other vessels are used for sputum, water should be placed 
in them to prevent the sputum from drying, and thus blowing about 
the house. The sputum from these cups should be emptied into the 
fire every day and the cups boiled in water in order to kill the germs 
which stick to them. Paper cups may be bought, which may be 
burnt after using. 

Cloths used to cover sores of the neck should be burned. 


MANUAL ON TUBERCULOSIS. 


7 


All handkerchiefs or cloths used by those who have tuberculosis 
should be boiled before washing. Their cups, knives, spoons, and 
other dishes should also be boiled before washing. This will kill the 
germs which stick to them. 

The boiling of milk or the thorough cooking of meat or other food 
will kill any germs which they contain. 

Strong sunlight hills the germs. —Tuberculosis germs live but a few 
hours in the bright sunlight. They die sooner if the sun shines 
directly on them. Many Indian homes have only one window. 
More windows should be built and the sunlight allowed to make the 
whole house bright, and thus kill the germs which may be there. 

The sunlight should especially be let into the rooms of those who 
are sick. 

Bedding and clothing sould be frequently aired in the sun to kill 
the germs which may collect on them. 

The germs may be hilled by poisonous drugs. —When it is not pos¬ 
sible to burn or boil the articles containing the germs, poisonous 
drugs or gases should be used to kill them. 

Carbolic acid may be mixed with hot water and applied to 
clothing or other articles which have the germs on them. Six tea¬ 
spoonfuls of the acid to a pint of hot water makes a very strong 
solution. This is very poisonous. 

Bichloride of mercury is sold in small blue tablets. One of 
these dissolved in a pint of water makes a solution which may be 
used in the same way. This is also very poisonous. 

Carbolic acid or bichloride of mercury solution may be used to 
wash floors, walls, beds, or other furniture which has been used by 
persons having tuberculosis. 

Formaldehyde may be evaporated into a gas which will kill all 
kinds of germs. It is used for killing the germs in rooms and houses. 
Whenever a person dies of tuberculosis or leaves the house where 
he has been living, formaldehyde should be used to kill the germs 
which he leaves behind. The room should be tightly closed, all 
cracks being sealed by pasting paper over them. One pint of for¬ 
maldehyde is used for each 1,000 cubic feet of air in the room. Sheets 
wrung out of it may be hung in the room and the door quickly sealed 
and left so at least eight to ten hours. 

Carbolic acid, bichloride, and formaldehyde are all very poisonous 
and should be used only under the direction of a physician. 

HOW TO AVOID TUBERCULOSIS AND KEEP WELL. 

The chief cause of tuberculosis among the Indians is their method 
of living in their homes. 

Do not spit on the floor. —Spitting on the floor or around or near 
the house is a very common custom. In this way the houses become 
very quickly filled with the dust and tuberculosis germs from the 


8 


MANUAL ON TUBERCULOSIS. 


dried sputum, so that the people living in the house and breathing 
the dust take the disease. 

Members of the family, whether sick or well, should not spit on the 
floor of the house or on the paths or grounds around it, and they 
should not permit any visitors to do so. All sputum should be burned. 

Let light and fresh air into the house. —In many Indian homes there 
is but one sleeping room, where all the family sleep together. These 
rooms are frequently greatly crowded and sometimes have no win¬ 
dows, or only one window through which light and air may enter. 
When fresh air is not freely admitted to the room, it quickly becomes ' 
unhealthy, and if the room is crowded disease is spread from one 
person to another. 

The lungs require fresh air in order to remain strong. Windows 
should always be open in the sleeping rooms, even during very cold 
weather. During the winter warm blankets should be used, but the 
face should not be covered by them. 

Plenty of light and air should be allowed to enter the house in the 
daytime. If the rooms are dark, more windows should be built in 
order that the direct sunlight may enter. Sick persons should always 
sleep alone. 

Keep clean. —Cleanliness of the body, of clothing, of the home, of 
food, and of everything with which we come in contact is an important 
way of keeping our surroundings free from disease germs. In this 
way diseases caused by these germs are prevented. Soap and hot 
water, frequently used, is sufficient to kill or remove many tubercu¬ 
losis germs which may lodge in our homes or on our clothes or bodies. 

The hands and face should be washed and the teeth brushed before 
eating. The hands should be washed before handling food. Food 
should not be eaten from the floors, but from a clean table from clean 
dishes. Raw food, such as apples and pears, should be washed before 
eating, and all food should be kept covered and free from dust and 
flies. Drying meat, especially, should be protected from dust and 
flies. 

Do not raise a dust in house cleaning. —Sweeping should be done 
with a damp broom, or damp sawdust or other damp material should 
be scattered on floors beforehand. Dusting should be done with a 
damp cloth. 

Eat sufficient pure , clean, nourishing food.— The food which is eaten 
goes to build up the body and help it overcome disease. Bread, 
butter, milk, eggs, fresh meat, beans, rice, corn, flour, sugar, fresh 
vegetables, and fruit, well cooked and clean, if eaten in sufficient 
quantities and well chewed, are sufficient to keep the body strong 
and well nourished. 

Spend part of the day in the open air.—Not only should a person 
have plenty of air in the sleeping room at night, but he should spend 


MANUAL ON TUBERCULOSIS. 9 

a part of each day in the fresh air. Daily exercise out of doors will 
keep the body in good condition. 

WHAT TO DO IF YOU HAVE TUBERCULOSIS. 

Tuberculosis can be cured if treatment is begun early. 

Live in the fresh air ,—Spend all your time in the pure, fresh air- 
Sleep out of doors. If in the house, keep windows open at all times, 
both winter and summer. Use sufficient clothing and bed covering 
to keep the body warm; do not be overclad, but be comfortably clad. 
In cold climates protect the head and ears from cold, but do not 
cover the face with blankets. A screened porch is the best place to 
live. 

Take sufficient rest. —If there is fever, stay in bed. As the fever 
disappears and strength returns, exercise in the air and sunshine 
may be gradually taken. Do^ not exercise if there is chill or fever. 
Guard against weariness. Do not get overtired. Avoid excitement 
or strain of any kind, even if only for a short time. Use a reclining 
chair, in which rest may frequently be taken while not actually in bed. 

Eat regularly clean, plain, well-cooked, nourishing food, especially 
milk arid eggs. —Unless the body receives the proper food it will not 
overcome the disease. Milk and eggs are the best known foods for 
building up the body and helping it to overcome tuberculosis. 

Avoid patent medicines and alcohol—Consult the doctor. —The physi¬ 
cian should be called in and only such medicine taken as he shall 
direct. His advice should be followed. 

IF YOU HAVE TUBERCULOSIS DO NOT SPREAD IT TO OTHERS. 

Destroy all your sputum by fire. 

Do not spit on the floor or swallow your sputum. 

Cups used for sputum should be burned or boiled. 

Sleep alone. 

Use separate dishes. 

Do not pass the pipe. 

Have all clothes and dishes boiled before being washed. 

Use a piece of clean cloth as a handkerchief and hold it in front of 
the mouth while coughing. Burn it after using. 

Mothers who have tuberculosis should wean their children. 

When a person who has tuberculosis dies or moves out of a room 
the physician should be called to disinfect or kill all the germs in the 
room. 

HOW SANITARY CONDITIONS MAY BE IMPROVED. 

The following illustrations show how sanitary conditions may be 
improved by slight changes in the Indian homes and methods of 
living. Notice particularly the first three pictures, showing how 
easily the homes of Indians in the South may be bettered. 

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MANUAL OF TUBERCULOSIS. 


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MANUAL OF TUBERCULOSIS. 



Many Indian families have only one sleeping room. This shows how it may be arranged so that the family will remain healthy. Each child should have his own bed. The 
bedding should be kept clean. The floor should be kept clean and no one allowed to spit on it. The walls should be as clean and smooth as possible. There should be 
several large windows which are kept open so that plenty of light and air may enter. Each member of the family should have his own towel and hang it separate from 
the others. Each one should have his own toothbrush. The little pockets above the washstand are used for separate combs and toothbrushes. Clothes hot in use should 
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one should use a band instrument which has been used by others until all the germs on it have been killed. One 
should not put whistles, apples, chewing gum, or other objects in the mouth if they have been in the mouths of 
others. 











































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